MEDICARE: KIRK WERNER PROCHNIO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-2474	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA-2474	OTHER	CO	COLORADO LICENSURE

General Provider Information

NPI Number	:	1861666489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK WERNER PROCHNIO PA-C

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 YOUNGFIELD ST
Second Line	:	STE 150
City	:	GOLDEN
State	:	CO
Zip	:	80401-2263
Country	:	US
Telephone Number	:	303-238-4277
Fax Number	:	303-238-4977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2026

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